Zwelling: Reform efforts will fail when decisions are driven by profit

By Leonard Zwelling

Updated 5:17 pm, Saturday, December 14, 2013

The ObamaCare (Cyber) War wages on. Was the Affordable Care Act a good idea or a terrible one? Before deciding that, what the heck was the idea behind the law anyway?

My father was an industrial engineer who loved mathematics. He taught me two rules for solving all math problems. First, define the problem. Second, don't divide by zero. I think I used the latter advice only twice in my life, but the first, I continue to use every day as I did in medical and business school.

Then I went to Capitol Hill as a U.S. Senate staffer during the opening months of the health care reform debate in 2009. To me, the problem of health care reform was threefold: reducing the American expenditure on health care (estimated at about $2.7 trillion annually); increasing access to health care, particularly for those without it or without a means to pay for it (i.e., insurance); and increasing the quality of health care, although there still is no consensus on what this looks like.

The problem, I quickly realized, was that my idea of the problem of health care reform and that of the Congress and the entrenched interests I call the health care-industrial complex (with all due deference to President Dwight Eisenhower's military-industrial complex) were not the same.

Norman Ornstein, a scholar at the American Enterprise Institute and one of the leading experts on the workings of Congress, summed it up in one sentence during a briefing for the press and politicos in November 2008. He said:

"Everyone's idea of health care reform is the same: I pay less."

Where I was trying to get my head around a solution to the three tenets of my idea of health care reform, everyone around me was trying to preserve or increase his piece of the health care payoff pie. I was looking for a legislative solution to assist the country in arriving at the place where the rest of the civilized world was - the provision of some form of universal health care as a right of citizenship. Everyone else was looking to cut a deal that preserved his place at the trough of health care profiteering. Guess who won?

With the full cooperation of the Congress and the White House, health care was not even remotely reformed. The Affordable Care Act is not about health care reform. It is about money, particularly preserving the insurance industry's hold over how health care dollars are spent.

In theory, even before the Supreme Court worked its Medicaid mischief, the bill preserved the private insurance market and gave it 30 million more customers (the denial of Medicaid expansion by many governors and state legislatures as permitted by the Supreme Court shrunk that pot of potential beneficiaries to some extent and healthcare.gov did the rest). The drug companies benefited from the changes in Medicare that incentivized the use of brand name drugs in the "donut hole," where seniors have to cover their own drug costs.

The Affordable Care Act continued to allow hospitals to jack up prices with no relation to actual costs. Only the doctors gave up something because, unlike the insurance industry and the pharmaceutical industry, medicine did not speak with one voice when lobbying on Capitol Hill and thus could largely be ignored. This is health care reform? I don't think so.

The reason the Affordable Care Act did what it did is because that's what it aimed to do - increase access to insurance for the uninsured, get everyone else to pay for it, and make sure no one currently in the health care business loses a dollar from the amounts they are already extracting from patients and doctors alike.

I went to D.C. expecting to work on health care reform, not the preservation of a system that uses health care provision as a source of profit and leaves at least 15 percent of Americans to fend for themselves in emergency rooms.

Thus, at this point, I would normally say start again with health care reform. But perhaps first, we need to define the problem we wish to solve. If we got that right, perhaps then we would get a law that both political parties could agree on and that would actually help all Americans and the country we love.